Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy

Detalhes bibliográficos
Autor(a) principal: Ciampi, Quirino
Data de Publicação: 2021
Outros Autores: Olivotto, Iacopo, Peteiro, Jesus, D’Alfonso, Maria, Mori, Fabio, Tassetti, Luigi, Milazzo, Alessandra, Monserrat, Lorenzo, Fernandez, Xusto, Pálinkás, Attila, Pálinkás, Eszter, Sepp, Róbert, Re, Federica, Cortigiani, Lauro, Tesic, Milorad, Djordjevic-Dikic, Ana, Beleslin, Branko, Losi, Mariangela, Canciello, Grazia, Betocchi, Sandro, Lopes, Luis, Cruz, Ines, Cotrim, Carlos, Torres, Marco, Bellagamba, Clarissa, Van De Heyning, Caroline, Varga, Albert, Ágoston, Gergely, Villari, Bruno, Lorenzoni, Valentina, Carpeggiani, Clara, Picano, Eugenio
Tipo de documento: Artigo
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10400.1/15454
Resumo: Background: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test. Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM). Methods: We enrolled 917 HCM patients (age = 49 +/- 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (>= 50 mmHg) in 281 (30.4%). HRR was 1.90 +/- 0.40 (lowest quartile <= 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018-1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009-1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708-0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043-2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36-145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116-4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441-7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043-1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037-1.128, p < 0.001). Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients.
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spelling Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathyAutonomic dysfunctionStress echocardiographyHypertrophic cardiomyopathyBackground: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test. Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM). Methods: We enrolled 917 HCM patients (age = 49 +/- 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (>= 50 mmHg) in 281 (30.4%). HRR was 1.90 +/- 0.40 (lowest quartile <= 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018-1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009-1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708-0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043-2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36-145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116-4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441-7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043-1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037-1.128, p < 0.001). Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients.MDPISapientiaCiampi, QuirinoOlivotto, IacopoPeteiro, JesusD’Alfonso, MariaMori, FabioTassetti, LuigiMilazzo, AlessandraMonserrat, LorenzoFernandez, XustoPálinkás, AttilaPálinkás, EszterSepp, RóbertRe, FedericaCortigiani, LauroTesic, MiloradDjordjevic-Dikic, AnaBeleslin, BrankoLosi, MariangelaCanciello, GraziaBetocchi, SandroLopes, LuisCruz, InesCotrim, CarlosTorres, MarcoBellagamba, ClarissaVan De Heyning, CarolineVarga, AlbertÁgoston, GergelyVillari, BrunoLorenzoni, ValentinaCarpeggiani, ClaraPicano, Eugenio2021-04-27T17:43:05Z20212021-01-01T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfhttp://hdl.handle.net/10400.1/15454eng2077-038310.3390/jcm10071347info:eu-repo/semantics/openAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-07-24T10:27:52Zoai:sapientia.ualg.pt:10400.1/15454Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T20:06:16.883532Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
title Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
spellingShingle Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
Ciampi, Quirino
Autonomic dysfunction
Stress echocardiography
Hypertrophic cardiomyopathy
title_short Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
title_full Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
title_fullStr Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
title_full_unstemmed Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
title_sort Prognostic value of reduced heart rate reserve during exercise in hypertrophic cardiomyopathy
author Ciampi, Quirino
author_facet Ciampi, Quirino
Olivotto, Iacopo
Peteiro, Jesus
D’Alfonso, Maria
Mori, Fabio
Tassetti, Luigi
Milazzo, Alessandra
Monserrat, Lorenzo
Fernandez, Xusto
Pálinkás, Attila
Pálinkás, Eszter
Sepp, Róbert
Re, Federica
Cortigiani, Lauro
Tesic, Milorad
Djordjevic-Dikic, Ana
Beleslin, Branko
Losi, Mariangela
Canciello, Grazia
Betocchi, Sandro
Lopes, Luis
Cruz, Ines
Cotrim, Carlos
Torres, Marco
Bellagamba, Clarissa
Van De Heyning, Caroline
Varga, Albert
Ágoston, Gergely
Villari, Bruno
Lorenzoni, Valentina
Carpeggiani, Clara
Picano, Eugenio
author_role author
author2 Olivotto, Iacopo
Peteiro, Jesus
D’Alfonso, Maria
Mori, Fabio
Tassetti, Luigi
Milazzo, Alessandra
Monserrat, Lorenzo
Fernandez, Xusto
Pálinkás, Attila
Pálinkás, Eszter
Sepp, Róbert
Re, Federica
Cortigiani, Lauro
Tesic, Milorad
Djordjevic-Dikic, Ana
Beleslin, Branko
Losi, Mariangela
Canciello, Grazia
Betocchi, Sandro
Lopes, Luis
Cruz, Ines
Cotrim, Carlos
Torres, Marco
Bellagamba, Clarissa
Van De Heyning, Caroline
Varga, Albert
Ágoston, Gergely
Villari, Bruno
Lorenzoni, Valentina
Carpeggiani, Clara
Picano, Eugenio
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.contributor.none.fl_str_mv Sapientia
dc.contributor.author.fl_str_mv Ciampi, Quirino
Olivotto, Iacopo
Peteiro, Jesus
D’Alfonso, Maria
Mori, Fabio
Tassetti, Luigi
Milazzo, Alessandra
Monserrat, Lorenzo
Fernandez, Xusto
Pálinkás, Attila
Pálinkás, Eszter
Sepp, Róbert
Re, Federica
Cortigiani, Lauro
Tesic, Milorad
Djordjevic-Dikic, Ana
Beleslin, Branko
Losi, Mariangela
Canciello, Grazia
Betocchi, Sandro
Lopes, Luis
Cruz, Ines
Cotrim, Carlos
Torres, Marco
Bellagamba, Clarissa
Van De Heyning, Caroline
Varga, Albert
Ágoston, Gergely
Villari, Bruno
Lorenzoni, Valentina
Carpeggiani, Clara
Picano, Eugenio
dc.subject.por.fl_str_mv Autonomic dysfunction
Stress echocardiography
Hypertrophic cardiomyopathy
topic Autonomic dysfunction
Stress echocardiography
Hypertrophic cardiomyopathy
description Background: Sympathetic dysfunction can be evaluated by heart rate reserve (HRR) with exercise test. Objectives: To determine the value of HRR in predicting outcome of patients with hypertrophic cardiomyopathy (HCM). Methods: We enrolled 917 HCM patients (age = 49 +/- 15 years, 516 men) assessed with exercise stress echocardiography (ESE) in 11 centres. ESE modality was semi-supine bicycle in 51 patients (6%), upright bicycle in 476 (52%), and treadmill in 390 (42%). During ESE, we assessed left ventricular outflow tract obstruction (LVOTO), stress-induced new regional wall motion abnormalities (RWMA), and HRR (peak/rest heart rate, HR). By selection, all patients completed the follow-up. Mortality was the predetermined outcome measure Results: During ESE, RWMA occurred in 22 patients (2.4%) and LVOTO (>= 50 mmHg) in 281 (30.4%). HRR was 1.90 +/- 0.40 (lowest quartile <= 1.61, highest quartile > 2.13). Higher resting heart rate (odds ratio 1.027, 95% CI: 1.018-1.036, p < 0.001), older age (odds ratio 1.021, 95% CI: 1.009-1.033, p < 0.001), lower exercise tolerance (mets, odds ratio 0.761, 95% CI: 0.708-0.817, p < 0.001) and resting LVOTO (odds ratio 1.504, 95% CI: 1.043-2.170, p = 0.029) predicted a reduced HRR. During a median follow-up of 89 months (interquartile range: 36-145 months), 90 all-cause deaths occurred. At multivariable analysis, lowest quartile HRR (Hazard ratio 2.354, 95% CI 1.116-4.968 p = 0.025) and RWMA (Hazard ratio 3.279, 95% CI 1.441-7.461 p = 0.004) independently predicted death, in addition to age (Hazard ratio 1.064, 95% CI 1.043-1.085 p < 0.001) and maximal wall thickness (Hazard ratio 1.081, 95% CI 1.037-1.128, p < 0.001). Conclusions: A blunted HRR during ESE predicts survival independently of RWMA in HCM patients.
publishDate 2021
dc.date.none.fl_str_mv 2021-04-27T17:43:05Z
2021
2021-01-01T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
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dc.identifier.uri.fl_str_mv http://hdl.handle.net/10400.1/15454
url http://hdl.handle.net/10400.1/15454
dc.language.iso.fl_str_mv eng
language eng
dc.relation.none.fl_str_mv 2077-0383
10.3390/jcm10071347
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dc.publisher.none.fl_str_mv MDPI
publisher.none.fl_str_mv MDPI
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instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
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